References - Three-Part fractures of the proximal humerus
Prosthetic arthroplasty for fractures and fracture-dislocations of the proximal humerus.
Tanner MW, Cofield RH
Clin Orthop
1983 Oct;(179):116-28
During the period from 1970 through 1979, proximal humeral arthroplasty with prostheses of the Neer design was performed in
49 shoulders
(48 patients) with complex acute or chronic fractures and fracture-dislocations of the proximal humerus. Follow-up evaluation included physical and roentgenographic examination
at least two years
after surgery for 43 of the 48 patients and averaged 38 months (range, 2-10 years). Of the 43 patients with adequate follow-up evaluation, 16 had acute and 27 (1 bilateral) had chronic fracture problems.
Pain relief
was satisfactory in all of the 16 shoulders with acute fractures and in 25 of the 28 shoulders with chronic fracture problems.
Active abduction averaged 101 degrees
in the acute fracture group (range, 35 degrees-160 degrees) and
112 degrees
in the chronic fracture group (range, 20 degrees-180 degrees). Complications in shoulders with acute fractures were associated with problems in
tuberosity and rotator cuff healing
.
Complications were more frequent in shoulders with chronic fractures and fracture-dislocations
, and were generally related to surgical difficulty, extensive tissue scarring, and distortion of anatomy. The Neer prosthesis affords satisfactory pain relief for both acute and chronic complex fracture-dislocations of the proximal humerus, but the return of function is governed by the security of tuberosity-muscle cuff repair, sufficient protection after operation, and long-term physiotherapy. If possible, surgery should be performed early to avoid the scarring and inelasticity that engender complications and limit functional recovery in shoulders with chronic fractures.
Assessment and management of three-and four-part proximal humeral fractures.
Rees J, Hicks J, Ribbans W
Clin Orthop
1998 Aug;(353):18-29
Department of Orthopaedics, Northampton General Hospital, England.
Three-and four-part comminuted fractures of the proximal humerus are difficult and technically demanding to treat. The various treatment methods reported in the literature are reviewed. It is recommended that three-part fractures be treated with open reduction and internal fixation. Four-part fractures in the younger, active patient also can be treated successfully with open reduction and internal fixation. However, in the elderly and in the patient with osteoporosis, a hemiarthroplasty is the treatment of choice. There is a need for universal agreement on a scoring system for measuring outcome in these fractures to allow a meaningful comparison between reported treatment methods.
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